September 28, 2022
In this issue, read about published research on the safety, acceptability, and feasibility of a medication abortion telemedicine model in Mexico, a comment on the limitations of randomized trials of medication abortion as well as details of a new study to further the evidence-base for a later first trimester medication abortion regimen and early findings from a pilot study exploring an ‘asynchronous’ approach to medication abortion care. Find out also about our speaking engagements and recent publications.
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Published Research & Comment |
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TeleAborto: Guided Self-Managed Abortion is Safe, Acceptable and Feasible in Mexico |
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A study published in Contraception shows that guided self-managed abortion is safe, acceptable and feasible in Mexico when supportive care is provided from a distance. Among the 9 in ten people contacted after receiving phone or videoconference counselling through TeleAborto and abortion pills dispensed by mail, most (93%) reported successfully ending their pregnancies with the medications provided and without further intervention. A summary of the key findings is available in Spanish and English. We are collaborating with public and additional private providers through this ongoing direct-to-patient telemedicine service in an effort to reach more vulnerable and remote populations in Mexico.
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Comment: Randomized Trials of Medication Abortion Provide Some But Not All the Answers |
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The president of Gynuity Health Projects and the medical director of British Pregnancy Advisory Service (BPAS) comment in The Lancet on the need to think beyond randomized controlled trials to generate evidence for new ways to provide medication abortion. In the companion piece to a paper by Endler et al., Beverly Winikoff and Patricia Lohr say that the evidence for the safety, effectiveness, and acceptability of medication abortion is overwhelmingly clear. Providers, policy makers, and regulators need evidence from randomized trials, but there are more complexities to the delivery, receipt, and experience of this type of health care which might not be best answered by study designs that explore few outcomes and are curtailed by strict entry criteria.
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New Study to Further the Evidence-Base for a Later First Trimester Medication Abortion Regimen
Gynuity Health Projects has initiated the third in a trilogy of studies to further the evidence for extending the gestational age limit for outpatient medication abortion beyond 70 days of pregnancy. We are launching with four clinics in the U.S. to explore more rigorously the efficacy at 71-77- and 78-84-days' gestation of a regimen that uses one 200mg dose of mifepristone followed in 24 to 48 hours by two doses of 800mcg misoprostol, taken buccally four hours apart. The study will also evaluate side effects as well as client experience with the intervention. This regimen proved highly promising in our earlier study, meriting further investigation.
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MA-ASAP Study: Simplified Medication Abortion Care Over the Web |
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Our MA-ASAP pilot study is progressing very well. We have enrolled 66 people (out of a total of 200) and provided treatment to 50 of them since we started enrollment in late Spring. Both clients and providers are so far highly satisfied with this new model, which allows people to solicit care outside of normal clinic hours and clinicians to streamline their work. The study is evaluating the use of a web-based website and surveys to provide medication abortion care without a real-time video or phone interaction between client and clinician. Available via Planned Parenthood health centers in Minnesota and Colorado, this ‘asynchronous’ method of care is open to people in these two states who are aged 18 and over. Discover more www.ma-asap.org
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Podcast: Invisibilia Brings Expert Insight into the Concept of Period Pills
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In the most recent episode of an NPR podcast series, the Invisibilia team bring expert insight into the concept of period pills—medications that induce menstrual bleeding or early pregnancy loss. This option ensures non-pregnancy without first establishing whether or not a pregnancy exists and is formally promoted in some countries as a form of fertility control. The episode “A Little Bit Pregnant” includes clips from an interview with senior consulting associate, Wendy Sheldon, who highlights Gynuity’s work in this area. Listen now. Period pills are available via telemedicine in certain U.S. states. Discover more www.periodpills.org.
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Save the Date: International Conference of Family Planning (ICFP), Thailand, November 17, 2022 |
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A retrospective analysis by Gynuity Health Projects and Women Help Women (WHW) of the latter’s online telemedicine medication abortion service will be presented at the ICFP. Our colleague, Lucía Berro Pizzarossa, will represent the research team on November 17 (11:50am - 1:10pm) during a panel discussion about de-medicalizing medication abortion and post-abortion contraception. We have submitted for peer-review our analysis of one year of WHW’s service delivery data. |
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14th International Federation of Abortion and Contraception Professionals (FIAPAC) Conference in Riga, Latvia – September 2022 |
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We warmly congratulate our colleague, Anand Tamang (CREHPA), who was awarded the best poster prize at the FIAPAC conference held earlier this month. His presentation highlighted unpublished results from our collaborative study implemented in two public hospitals in Nepal, which showed that an outpatient second trimester (13-18 weeks) induction abortion service is safe, feasible and highly acceptable. A separate analysis found the new model to be cost-effective, and it has since been introduced into routine care at the two hospitals.
Our official program of activities at the meeting included a second poster presentation by senior consulting associate Tamar Tsereteli, who summarized a study evaluating the omission of mandatory facility-based tests for telemedicine medication abortion in Ukraine and Uzbekistan, and a plenary presentation by Beverly Winikoff on the lessons that can be borrowed from history to ensure social and political environments that value inclusion, autonomy, and equality in relation to abortion.
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Peña, M., Flores, K.F., Ponce, M.M., Serafín, D.F., Camarillo Zavala, A.M., Cruz, C.R., Ortiz Salgado, I.G., Ochoa Rosado, Y., Socarras, T., López, A.P., Bousiéguez. M. Telemedicine for Medical Abortion Service Provision in Mexico: A Safety, Feasibility, and Acceptability Study. Contraception; 2022 Jun 23; S0010-7824(22)00164-0; doi:10.1016/j.contraception.2022.06.009. Online ahead of print.
Comendant, R., Cook, C., Hodorogea, S., Sagaidac, I., Bubulici, C., Platais, I. Medical Abortion via Telemedicine for Women and Adolescents: Experience from Moldova. Reproductive Female and Child Health; March 22, 2022; doi: https://doi.org/10.1002/rfc2.3.
Mark, A., Roberts, R., Foster, A.M., Prager, S.W., Ryan, R., Winikoff, B. "Who is Driving You Home Today?" Escort Policies as a Barrier to Abortion Access. Contraception; April 01, 2022; Vol. 108:4-6. doi: 10.1016/j.contraception.2021.12.012; Epub 2022 Jan 11.
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September 28th is an annual international day of action in support of access to safe and legal abortion. Please consider supporting our work, which recognizes abortion as essential health care and is driven by a deep passion to strengthen and protect universal access to the full range of reproductive health care options. |
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